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Capture the most specific ICD-10-CM codes to report opioid use disorders

11/04/2019

by: Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC

Understanding how to document and code for opioid use and abuse is critical to ensure accurate provider reimbursement. Also, remember that clinical data on opioid use is collected by the National Institute on Drug Abuse (NIDA) and other medical agencies to support research on strategies for preventing opioid misuse, treating opioid use disorders and managing pain.

Treating patients in the parking lot: You can, but proceed with caution

11/04/2019

by: Roy Edroso

Question: I saw a TV news story recently about how a doctor in Massachusetts treated patients in a parking lot when a power outage made her office unusable. “One patient, I saw in the car,” the doctor said. Was that a good idea? Shouldn’t they have sent their patients to another practice or rescheduled?

Practices cite prior authorizations, QPP as most burden-inducing regs, survey finds

11/04/2019

by: Jim Dresbach

The past three regulatory burden surveys from the Medical Group Management Association (MGMA) point to prior authorizations, Medicare’s Quality Payment Program (QPP) and audits and appeals as the biggest culprits in draining money and time from medical practices.

Final 2020 Medicare physician fee schedule

11/01/2019

by: DecisionHealth staff

This major final rule aligns the E/M coding and payment with changes recommended by the CPT Editorial Panel and AMA RUC for office/outpatient E/M visits. The final rule also adds services to the telehealth list and updates payment policies, payment rates and other provisions for services furnished under the Medicare physician fee schedule on or after Jan. 1, 2020.

Modifier 22 Decision Tree

11/01/2019

Modifier 22 indicates "increased procedural services." Incorporate the tips below and click the "Download file" link above to access a modifier 22 decision tree.

As MIPS audits get rolling, protect yourself with proof files of your submissions

10/28/2019

by: Roy Edroso

If you’re worried that your simple attestations to certain Merit-based Incentive Payment System (MIPS) measures and improvement activities (IA) may be subject to audits down the road, it’s a good idea to put proof that you reported correctly into a file — and make sure what’s in it will be convincing to the authorities.

Break through with an honest discussion when talking opioids with patients

10/28/2019

by: James Dresbach

You should take a deliberate approach in how you frame your conversations with patients who are starting on an opioid prescription or those who show signs of an opioid use disorder (OUD). Building out a script will allow you to discuss risks without alienating your patients.

3 indispensable prep steps to successfully appeal denials and takebacks

10/28/2019

by: Roy Edroso

Protect yourself against denials and takeback attempts by deputizing a point person and arming her with tools and protocols to stay on top of payer demands and effectively parry them. In some cases, you may even be able to hold onto money you actually owe.

Complications drop off HCC risk scores if your provider doesn’t address them

10/28/2019

by: Roy Edroso

Question: Say a doctor sees a diabetic patient, notes blood sugar and increases the insulin dose. The chart includes diagnosis codes for diabetes mellitus (DM) with nephropathy (E11.21) and polyneuropathy (E11.42), but the notes do not otherwise address the polyneuropathy and nephropathy. For risk adjustment purposes, would this map to hierarchical condition category (HCC) 18 (Diabetes with chronic complications) or to HCC 19 (Diabetes without complication)? And if the nephropathy and polyneuropathy are not addressed in encounters, would the patient map to HCC 19, notwithstanding that he was diagnosed with them?

Teaching physicians find eased documentation standards for E/M services

10/28/2019

by: Richard Scott

Question: I saw a recent policy update from CMS about teaching physicians performing E/M services but I can’t understand what it means. Please help!

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